POS0450 MORTALITY AND CAUSES OF DEATH IN A LARGE COHORT OF PATIENTS WITH RHEUMATOID ARTHRITIS: A POPULATION-BASED STUDY
Authors: F. Vesentini, M. Zen, L. Salmaso, C. Barbiellini Amidei, U. Fedeli, S. Bellio, F. Arru, A. Giollo, M. Saia, A. Doria
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Whether or not in the last years mortality is still increased in RA patients compared to the general population is controversial. <h3>Objectives</h3> To assess mortality rates (MRs), standardized mortality ratios (SMRs), and causes of death in Rheumatoid Arthritis (RA) in a population-based study. <h3>Methods</h3> We analyzed linked administrative health databases of the Veneto Region (Italy, 4,900,000 residents): the population registry, where all residents are recorded, was linked with healthcare co-payments exemptions, hospital discharge records, and mortality records. RA was defined by a healthcare copayment exemption for or any hospital diagnosis of RA. We analyzed all-cause mortality until December 31, 2020. MRs per 1,000 were stratified by year, sex, and age group. SMRs were derived, by comparing MRs of the general regional population. Causes of death were coded using the ICD-10 coding system and were available until 31/12/2020; they were grouped in: RA, infectious diseases, cardiovascular diseases (CVD), cancer, diabetes, or others. <h3>Results</h3> Between 2012 and 2020, 7,435 deaths among 37,996 RA prevalent cases occurred, corresponding to an average annual standardized MR of 32.2 (95% CI 31.5; 33.0) per 1,000 persons. The median (IQR) age at death was 83 years (77-88), lower in males (81, 75-86) compared to females (84, 78-89). Standardized MR was higher in males than in females (41.3, 95% 39.05-43.2 vs. 29.5, 95% CI 28.7-30.3); notably, this was true across all age groups (Table 1). Causes of death were CVD 2,735 (37.1%), cancer 1,519 (20.6%), infections 827 (11.2%), RA 352 (4.8%), diabetes 208 (2.8%), trauma, poisoning, or post-surgical/procedural complications 197 (2.7%), and others 1,532 (20.6%). Out of 12,875 incident RA patients, 1,288 died during the study period, corresponding to a mortality rate of 21.3 (95% CI 20.2-22.5). The distribution of causes of death among incident cases was comparable to that observed among prevalent cases. Overall SMR was 1.28 (95% CI 1.21-1.35) and was higher in younger patients (&lt;45 years old: 2.15, 95% CI 0.93-4.24) (Figure 1). Eight-year survival was significantly affected by age at diagnosis: 98.8% (95% CI 98.1%-99.2%) in patients aged &lt;50 years, 95.8% (94.5%-96.8%) in patients aged 50-59, 94.2% (92.2%-95.7%) in patients aged 60-64, 84.1% (81.7%-86.2%) in those aged 65-75, and 48.4% (45%-51.6%) in those aged &gt;75 years. <h3>Conclusion</h3> Standardized mortality ratio is slightly increased in RA patients compared to the general population, especially in younger patients. Despite that, eight-year survival in subjects &lt;49 is good. CVD and cancer represent the main causes of death in RA, whereas therapy-related complications such as infections account for a low proportion of deceases. <h3>REFERENCES:</h3> NIL. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.